Get Involved Please complete the following Get Involved! Form indicating how you would like to help in the OHSU PA Program. Full Name First Name Last Name Preferred Method of Contact - Select -EmailPhone Email Address Phone Practice Specialty Practice Name Practice Address Practice Address Practice City/Town Practice State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Practice ZIP/Postal Code Practice Phone Number I am interested in supporting the PA Program by Mentoring a first year student Precepting a second year student Serving on a committee Giving a lecture Helping with physical examination class or lab Proctoring clinical examinations Becoming a small group facilitator If you check lecture above, which topic areas? If you checked serve on a committee, which one? - Select -Admissions CommitteeCurriculum CommitteeProgress & Promotions Committee Additional Comments Leave this field blank
Get Involved Please complete the following Get Involved! Form indicating how you would like to help in the OHSU PA Program. Full Name First Name Last Name Preferred Method of Contact - Select -EmailPhone Email Address Phone Practice Specialty Practice Name Practice Address Practice Address Practice City/Town Practice State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Practice ZIP/Postal Code Practice Phone Number I am interested in supporting the PA Program by Mentoring a first year student Precepting a second year student Serving on a committee Giving a lecture Helping with physical examination class or lab Proctoring clinical examinations Becoming a small group facilitator If you check lecture above, which topic areas? If you checked serve on a committee, which one? - Select -Admissions CommitteeCurriculum CommitteeProgress & Promotions Committee Additional Comments Leave this field blank